Exploring Massachusetts Health Care Reform Impact on Fee-For-Service Funded Substance Use Disorder Treatment Providers

The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006 -2007 that included expanding coverage for SUD treatment. This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for- service funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication assisted treatment. Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the AC

Integration of Care in the Implementation of the Affordable Care Act: Changes in Treatment Services in a National Sample of Centers Treating Substance Use Disorders

This study examined patterns of medicalization in substance use disorder (SUD) that are aligned with the goals of the Affordable Care Act (ACA). Using a nationally representative sample of SUD treatment programs, we examined changes in several treatment domains. While observed changes were modest, they were in directions that support the thrust of the ACA. Specifically, we found an increase in the percentage of treatment referrals from other health care providers. We found an increase in the number of physicians for programs that did have a physician on staff, and an increase in counselors certified in treating alcohol and drug addiction. There was sig- nificant growth in the availability of oral and injectable naltrexone but not of other pharma- cotherapies. There was a decrease in support for the 12-step model and an increase on the emphasis of a medicalized treatment model. Finally, we found a shift away from federal block grants and other public funding, consistent with the expectations of the ACA. These data indicate that, while progress is slow, the environment of the recent past has been supportive of the goal of SUD treatment’s integration into mainstream medical care

Capillary origami: spontaneous wrapping of a droplet with an elastic sheet

The interaction between elasticity and capillarity is used to produce three dimensional structures, through the wrapping of a liquid droplet by a planar sheet. The final encapsulated 3D shape is controlled by tayloring the initial geometry of the flat membrane. A 2D model shows the evolution of open sheets to closed structures and predicts a critical length scale below which encapsulation cannot occur, which is verified experimentally. This {\it elastocapillary length} is found to depend on the thickness as $h^{3/2}$, a scaling favorable to miniaturization which suggests a new way of mass production of 3D micro- or nano-scale objects.Comment: 5 pages, 5 figure

Phase-slip avalanches in the superflow of 4^4He through arrays of nanopores

Recent experiments by Sato et al. [1] have explored the dynamics of $^4$He superflow through an array of nanopores. These experiments have found that, as the temperature is lowered, phase-slippage in the pores changes its character, from synchronous to asynchronous. Inspired by these experiments, we construct a model to address the characteristics of phase-slippage in superflow through nanopore arrays. We focus on the low-temperature regime, in which the current-phase relation for a single pore is linear, and thermal fluctuations may be neglected. Our model incorporates two basic ingredients: (1) each pore has its own random value of critical velocity (due, e.g., to atomic-scale imperfections), and (2) an effective inter-pore coupling, mediated through the bulk superfluid. The inter-pore coupling tends to cause neighbours of a pore that has already phase-slipped also to phase-slip; this process may cascade, creating an avalanche of synchronously slipping phases. As the temperature is lowered, the distribution of critical velocities is expected to effectively broaden, owing to the reduction in the superfluid healing length, leading to a loss of synchronicity in phase-slippage. Furthermore, we find that competition between the strength of the disorder in the critical velocities and the strength of the inter-pore interaction leads to a phase transition between non-avalanching and avalanching regimes of phase-slippage. [1] Sato, Y., Hoskinson, E. Packard, R. E. cond-mat/0605660.Comment: 8 pages, 5 figure

Controlled Production of Sub-Radiant States of a Diatomic Molecule in an Optical Lattice

We report successful production of sub-radiant states of a two-atom system in a three-dimensional optical lattice starting from doubly occupied sites in a Mott insulator phase of a quantum gas of atomic ytterbium. We can selectively produce either sub-radiant 1g state or super-radiant 0u state by choosing the excitation laser frequency. The inherent weak excitation rate for the sub-radiant 1g state is overcome by the increased atomic density due to the tight-confinement in a three-dimensional optical lattice. Our experimental measurements of binding energies, linewidth, and Zeeman shift confirm observation of sub-radiant levels of the 1g state of the Yb_2 molecule.Comment: To be published in Phys. Rev. Let

Alcohols increase calmodulin affinity for Ca2+ and decrease target affinity for calmodulin

AbstractIt has been proposed that alcohols and anesthetics selectively inhibit proteins containing easily disrupted motifs, e.g., α-helices. In this study, the calcineurin/calmodulin/Ca2+ enzyme system was used to examine the effects of alcohols on calmodulin, a protein with a predominantly α-helical structure. Calcineurin phosphatase activity and Ca2+ binding were monitored as indicators of calmodulin function. Alcohols inhibited enzyme activity in a concentration-dependent manner, with two-, four- and five-carbon n-alcohols exhibiting similar leftward shifts in the inhibition curves for calmodulin-dependent and -independent activities; the former was slightly more sensitive than the latter. Ca2+ binding was measured by flow dialysis as a direct measure of calmodulin function, whereas, with the addition of a binding domain peptide, measured calmodulin–target interactions. Ethanol increased the affinity of calmodulin for Ca2+ in the presence and absence of the peptide, indicating that ethanol stabilizes the Ca2+ bound form of calmodulin. An increase in Ca2+ affinity was detected in a calmodulin binding assay, but the affinity of calmodulin for calcineurin decreased at saturating Ca2+. These data demonstrate that although specific regions within proteins may be more sensitive to alcohols and anesthetics, the presence of α-helices is unlikely to be a reliable indicator of alcohol or anesthetic potency

Multiple equilibria in Tullock contests

We find the sufficient conditions for the existence of multiple equilibria in Tullock-type contests, and show that asymmetric equilibria arise even under symmetric prize and cost structures. We then present existing contests where multiple equilibria exist under reasonably weak conditions

Introducing a corpus of human-authored dialogue summaries in Portuguese

In this paper, we introduce a corpus of human-authored dialogue summaries collected through a web-experiment. The corpus features (i) one of the few existing corpora of written dialogue summaries; (ii) the only corpus available for dialogue summaries in Portuguese; and (iii) the only available corpus of summaries produced for dialogues whose participants’ politeness alignment was systematically varied. Comprising 1,808 human-authored summaries, produced by 452 summarisers, for four different dialogues, this is, to the best of our knowledge, the largest individual corpus available for dialogue summaries, with the highest number of participants involved

A Soft Budget Constraint Explanation for the Venture Capital Cycle

We explore why venture capital funds limit the amount of capital they raise and do not reinvest the proceeds. This structure is puzzling because it leads to a succession of several funds financing each new venture which multiplies the well known agency problems. We argue that an inside investor cannot provide a hard budget constraint while a less well informed outsider can. Therefore, the venture capitalist delegates the continuation decision to the outsider by ex ante restricting the amount of capital he has under management. The soft budget constraint problem becomes the more important the higher the entrepreneur’s private benefits are and the higher the probability of failure of a project is

The Spitzer discovery of a galaxy with infrared emission solely due to AGN activity

We present a galaxy (SAGE1CJ053634.78-722658.5) at a redshift of 0.14 of which the IR is entirely dominated by emission associated with the AGN. We present the 5-37 um Spitzer/IRS spectrum and broad wavelength SED of SAGE1CJ053634, an IR point-source detected by Spitzer/SAGE (Meixner et al 2006). The source was observed in the SAGE-Spec program (Kemper et al., 2010) and was included to determine the nature of sources with deviant IR colours. The spectrum shows a redshifted (z=0.14+-0.005) silicate emission feature with an exceptionally high feature-to-continuum ratio and weak polycyclic aromatic hydrocarbon (PAH) bands. We compare the source with models of emission from dusty tori around AGNs from Nenkova et al. (2008). We present a diagnostic diagram that will help to identify similar sources based on Spitzer/MIPS and Herschel/PACS photometry. The SED of SAGE1CJ053634 is peculiar because it lacks far-IR emission and a clear stellar counterpart. We find that the SED and the IR spectrum can be understood as emission originating from the inner ~10 pc around an accreting black hole. There is no need to invoke emission from the host galaxy, either from the stars or from the interstellar medium, although a possible early-type host galaxy cannot be excluded based on the SED analysis. The hot dust around the accretion disk gives rise to a continuum, which peaks at 4 um, whereas the strong silicate features may arise from optically thin emission of dusty clouds within ~10 pc around the black hole. The weak PAH emission does not appear to be linked to star formation, as star formation templates strongly over-predict the measured far-IR flux levels. The SED of SAGE1CJ053634 is rare in the local universe but may be more common in the more distant universe. The conspicuous absence of host-galaxy IR emission places limits on the far-IR emission arising from the dusty torus alone.Comment: Accepted for publication in A&A, 7 pages, 6 figure